IgM against rubella in a case of maculopapular exanthema caused by Epstein-Barr virus
Reference of this article: Sanz Moreno JC, Seijas Martínez-Echevarría L, Febrel Bordejé C, Sagües Cifuentes MJ, Fernández Díaz M, Mosquera Gutiérrez MM. IgM against rubella in a case of maculopapular exanthema caused by Epstein-Barr virus. Rev Pediatr Aten Primaria. 2003;5:225-228.
Published in Internet: 30-06-2003
Because the variety of virus causing maculopapular exanthemas the definitive diagnosis
of these process can be complicated. Te aim of this study is to present a case that raised problems in the differential diagnosis between the Epstein-Barr and the rubella viruses.
A girl twenty one months-old, immunised at the 15 months of age with MMR vaccine,
which presented a maculopapular exanthema of 5 days of evolution in face, neck and extremities
accompanied by febricula, cough, coriza and cervical adenopathies was studied. The
hemogram and the biochemical tests revealed a discreet leucocytosis (with prevalence of
lymphomonocytes) and elevation of transaminases. The serological results showed a profile
of recent infection by Epstein Barr virus (positive result for IgM-VCA and negative for IgGVCA
and IgG-EBNA). Other serological positive results included IgM and IgG against rubella
(the IgG-rubella avidity index was <80%). The PCR performed in pharyngeal exudates was
only positive for Epstein Barr virus.
Epstein Barr virus, besides being a possible agent producing of exanthemas, is a
polyclonal stimulator of B lymphocytes. In the present case its etiologic role seems to be
evident. The detection of Epstein-Barr by means of PCR, the serological profile of recent
infection by this virus, the antecedents of immunization with MMR vaccine and the result
of high avidity IgG-rubella suggest that the IgM positive result against the late agent
was caused by a polyclonal stimulation of lymphocytes generated after the MMR vaccination.
Keywords● Epstein-Barr virus ● Exanthema ● IgM ● Rubella